What is Long Head of Biceps Tenodesis?
Long head of biceps (LHB) tenodesis is a surgical procedure used to address pain or dysfunction in the long head of the biceps tendon, one of the two tendons that attach the biceps muscle to the shoulder. In this procedure, the long head of the biceps tendon is detached from its original attachment point inside the shoulder joint and reattached (or anchored) to the upper arm bone (humerus) outside of the shoulder joint.
The goal of the procedure is to relieve pain, restore shoulder function, and prevent further issues associated with the tendon.
Anatomy of the Long Head of Biceps
The biceps muscle has two tendons at its proximal end:
- Long head of the biceps tendon: Originates from the top of the glenoid (the “socket” of the shoulder joint) and runs through the bicipital groove of the humerus.
- Short head of the biceps tendon: Originates from the coracoid process of the scapula.
The long head tendon plays a role in shoulder stability, particularly in overhead activities. However, it is prone to injury or degeneration, especially in athletes or older individuals.
Why is Long Head of Biceps Tenodesis Performed?
LHB tenodesis is commonly performed to treat:
- Biceps Tendonitis: Inflammation or irritation of the tendon.
- SLAP Tears (Superior Labrum Anterior to Posterior): Injuries to the area where the long head tendon attaches to the labrum.
- Tendon Degeneration or Tears: Partial tearing or fraying due to overuse or aging.
- Shoulder Instability or Impingement: Where the tendon becomes compressed or damaged.
- Rotator Cuff Tears: Often combined with repair of torn rotator cuff muscles.
Symptoms that might lead to tenodesis include:
- Persistent shoulder pain, especially in the front of the shoulder.
- Weakness during overhead or rotational movements.
- A sensation of clicking or catching in the shoulder.
Procedure Overview
Preparation
- The surgery can be performed arthroscopically (using a camera through small incisions) or via open surgery.
- General or regional anesthesia is used.
Surgical Steps
- Accessing the Tendon: The surgeon makes an incision to locate the long head of the biceps tendon.
- Detachment: The damaged portion of the tendon is released from its attachment to the glenoid or labrum.
- Anchoring:
- The tendon is reattached to the humerus using a suture anchor, screw, or other fixation device.
- This is typically done outside of the shoulder joint to reduce friction and irritation.
- Closure: The surgical site is closed, and the shoulder is dressed.
The procedure is often combined with other shoulder surgeries, such as rotator cuff repair.
Benefits of LHB Tenodesis
- Pain Relief: Reduces or eliminates pain caused by tendon inflammation or injury.
- Improved Shoulder Function: Restores strength and range of motion for overhead and rotational movements.
- Prevention of Future Injury: Removes the problematic tendon portion and prevents it from causing ongoing issues.
Who is a Candidate?
Ideal candidates for LHB tenodesis include:
- Active individuals who need to maintain shoulder strength for sports or labor.
- Patients with chronic biceps tendon pain unresponsive to conservative treatments like physical therapy, anti-inflammatory medications, or injections.
- Patients undergoing other shoulder surgeries (e.g., rotator cuff repair) who also have biceps tendon damage.
Recovery and Rehabilitation
Post-Surgery Care
- Immobilization: The arm is placed in a sling for 2-4 weeks to protect the repair.
- Pain Management: Ice packs and medications to manage post-operative pain.
Rehabilitation Phases
- Phase 1 (0-6 weeks):
- Passive range of motion exercises under the guidance of a physical therapist.
- No lifting or resistance exercises.
- Phase 2 (6-12 weeks):
- Gradual introduction of active range of motion and strengthening exercises.
- Focus on rebuilding shoulder stability and mobility.
- Phase 3 (12+ weeks):
- Advanced strengthening and return to normal activities.
- Full recovery typically takes 4-6 months.
Risks and Complications
While LHB tenodesis is generally safe, potential complications include:
- Infection at the surgical site.
- Tendon Re-rupture: Failure of the repair, particularly with premature return to activity.
- Stiffness or Weakness: Delayed recovery of shoulder motion or strength.
- Nerve Injury: Rare but possible.
- Chronic Pain: Rare cases where pain persists despite surgery.
LHB Tenodesis vs. Tenotomy
Another surgical option for biceps tendon issues is tenotomy, where the tendon is simply released and not reattached.
| Feature | Tenodesis | Tenotomy |
|---|---|---|
| Tendon Reattachment | Yes | No |
| Cosmetic Appearance | No “Popeye deformity” (bulge in arm) | May result in “Popeye deformity” |
| Strength | Retains better strength for active individuals | Slight loss of strength possible |
| Recovery Time | Slightly longer (4-6 months) | Shorter (2-3 months) |
Conclusion
Long head of biceps tenodesis is a reliable surgical option for patients with biceps tendon injuries or pain that limits daily activities and athletic performance. It provides significant pain relief and functional improvement, particularly for active individuals. Consulting with an orthopedic surgeon is essential to determine whether tenodesis, tenotomy, or another treatment option is the best fit for your needs.
Would you like to explore the differences between tenodesis and other related procedures or learn more about rehabilitation protocols?